I HAD A LYMPHOMA/27

HIGH DOSE CHEMO/STEM CELL TREATMENT. Part 3

 INTO HOSPITAL

The last 2 Hubs {25/26 } have dealt with aspects leading up to the actual treatment administering, which as readers will know by now, is undertaken over a Hospital stay of 3/4 weeks. As this is potentially in the future for me, I am indebted once more to the British Leukaemia Charity for information on procedure as follows below.

Accommodation on admittance is to a single, double or bay room and as blood counts fall, the transition to single/isolation room takes place.During the stay, daytime clothing is encouraged and patients encouraged to keep occupied when well enough to do so. Psychologists and Psychotherapists are on hand if required, all of which underlines the severity of the treatment.

In some cases Radiotherapy is administered to ensure any remaining disease cells are destroyed before the healthy stem cells are returned to the body, whilst in other cases this function is performed via Chemotherapy.Administering this follows the way in which CHOP is administered and may be a mix of infusions and tablets, As with Chop additional tablets are prescribed to assist in dealing with side effects.

The rather dramatic term "DAY O" is used for the return of the stem cells. These are brought to bedside still frozen in liquid nitrogen, defrosted in a water bath and then infused over 10/15 minutes. Each bag of cells taken is returned in this way.. Intravenous fluids and a hydrocortisone injection and Piriton are given to counteract any reaction to the DSMO preservative used to protect the frozen cells.

Blood Pressure, temperature and pulse checks are undertaken regularly to monitor for reactions and if required an injection to counteract sickness. The latter results from the preservative apparently. Red urine, indicating dead red cells caught up when the cells were originally taken is usual at this time.

A total of 8 bags per day is the maximum return of stem cells, so if more were collected the process runs into another day.

SIDE EFFECTS OF TREATMENT.

As with Chop Treatment, side effects occur here and in many cases mirror those already experienced.

MUCOSITIS. This is a thinning of the mouth and gut linings and thus, ulcers and inflammation occurs affecting stomach, bowel and mouth. Mouth soreness is the usual harbinger of this effect and may need painkillers, even morphine to deal with the severity. Mouthwashes and dental care with a soft brush are important at this time, even more than normally.

NAUSEA/VOMITING. This is a common side effects and can also be caused by Mucositis as well as the preservative for the stem cells. Full anti-sickness medications are used to counteract this condition.

NEUTROPENIA/ INFECTION AND OTHER EFFECTS.. Having been Neutropenic 3 times whilst on Chop, I know this to be a condition relevant to a drop in the white cell count. Here the count drops to zero ,rendering the body open to infection for 7/14 days.Isolation is often vital at this time, as is normal hygiene activity to lessen the bacterial risk. This includes daily change of bed linen as well as normal washing and showering etc. Anaemia is another aspect and may be treated by blood transfusion. Anaemia produces tiredness, another side effect which in itself is normal. Patients can also bruise or bleed more easily than normal and, of course , hair loss is standard and loss of taste etc can also be common.

ENGRAFTMENT.

THIS IS THE TERM FOR THE PERIOD FOLLOWING THE RETURN OF THE STEM CELLS.DURING 10/14 DAYS INJECTIONS HELP TO STIMULATE THE BONE MARROW AND AS A RESULT THE WHITE CELL COUNT SLOWLY RISES AND SIDE EFFECTS BEGIN TO SUBSIDE. THESE ARE KEY TO RELEASE, FOR WHEN THE COUNT IS HIGH ENOUGH AND EATING AND DRINKING CAN BE DONE NORMALLY, THE PATIENT IS ALLOWED TO RETURN HOME.

POST HOSPITALISATION.

Out patient appointment is secured and prescribed drugs provided.As with Chop, the patient is advised to contact immediately if feeling unwell and at the outpatients, bloods and medications are checked. Subsequently referral is made back to the local Hospital Haematology Dept unless this was already determined on discharge.

2/6 months may be the time taken for recovery and during this time sensible precautions in things like eating and drinking, socialising and exercising etc are encouraged, as is the taking of holidays but after 6 months for travel abroad.

Thus, it will be seen from the above that this is a serious procedure and one not to be entered into lightly. In my case, much to listen to and question when I meet the Consultant on Thursday and having been able to seek out the above prior to that meeting is something I value highly and will use sensibly. A subsequent Hub will report fully on what transpires.

CURRENT SIDE EFFECTS.

As reported earlier the effects from Chop 8/ Intrathecal 4 are now slowly subsiding with toes and fingers returning to normality. Fingers quicker than toes. Tiredness lingers but as the report on High Dose etc above indicates ,this is normal, though I shall be pleased when it goes and I feel more energetic again.

Today I have my return to UROLOGY for the NOCTURIA problem. I go armed with a full bladder, having taken in much fluid to ensure I provide the full bladder measurement they require on site. I also have my 4 day Frequency and Volume Chart as requested. This involved making a calibrated container from a 2 litre ginger beer bottle to urinate into and marking each amount on the chart at the time of discharge. Also the amount of fluid taken in over each 24 hours is recorded likewise in a separate column. I note my AVERAGE Fluid/Urine levels per 24 hours are: Fluid Intake 3000 ml app. Urine discharge 2650 app. I have no idea what that means in the scheme of things but will no doubt discover today. Key for me is that night trips to the toilet have reduced to 1/2 in sleeping hours. Not perfect but better than before.

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